the patient

Question 1

what do we need to check for a drug chart

Answer 1

patient details
allergies
drugs prescribed
DH
drug classes
legalities
clinical check
medicinal notes, observational charts, biochem results

Question 2

ethnic differences in incidence
south asians in the uk
CHD

Answer 2

50% higher premature deaths in males and 51% in females. increasing

Question 3

ethnic differences in incidence
black Caribbean
CHD

Answer 3

35% lower CHD death rates than the rest of the population

Question 4

when is CVD the most common

Answer 4

if the person is male, older, has a severe mental illness or is south asian or African Caribbean

Question 5

what are the reasons for ethnic differences

Answer 5

multi factorial - not all genetic

differences in incidence of a number of CVD risk factors (hypertension, cholesterol, BMI, exercise. diet

diabetes is a major factor

Question 6

give some non modifiable risk factors for CVD

Answer 6

family history
premature CVD
older age
Being male
Ethnic background
comorbidities that can increase the risk of developing CVD

Question 7

what are some modifiable CVD

Answer 7

high blood pressure
high blood level of non high density lipoprotein
smoking and tobacco use
overweight and obesity
insufficient physical activity
poor diet
psychosocial stress
excess alcohol consumption.

Question 8

what are the links between hypertension and CVD

Answer 8

risk of cardiovascular disease is directly related to higher levels of BP

unhealthy diet and obesity

drug treatment and lifestyle changes can be effective in lowering BP

Question 9

describe the link between body weight and CVD

Answer 9

being overweight
obesity
both can increase risk of CVD, cancer and type 2 diabetes

BMI of 25 +

WHO recommends cut off points
wait to hip ratio cut off points

Question 10

describe the link between blood cholesterol and CVD

Answer 10

blood cholesterol is positively associated with CHD

blood cholesterol levels can be reduced by physical activity

HDL is an independent redictor
high levels are protective
low levels are increasing risk

Question 11

NHS health check programme

Answer 11

everyone aged 40-74 years old who don’t have CVD, diabetes or Chronic kidney disease is invited once every 5 years for a free health check

Question 12

what is the framingham study

Answer 12

began in 1949/50 with 5209 participants

at each study examination participants are evaluated with medical histories, physician examinations, lab tests, vascular risk factors, and some examinations with cognitive test batteries and brain

Question 13

what is QRISKr 2018

Answer 13

2.3 million practice participants in England and wales over 531 practices

multiple risk factor analysis of the patients

BMJ paper was published in 2017 and was published in 2018

Question 14

tips for lifestyle exercise per week

Answer 14

150 mins moderate intensity
75 mins vigorous
mix of moderate and vigorous aerobic activity
muscle strengthening activities on two or more days a week that work all
major muscle groups

Question 15

alcohol intake guidance guidelines

Answer 15

14 units per week
men and women

Question 16

what is mortality

Answer 16

Mortality rate, or death rate, is a measure of the number of deaths in a particular population, scaled to the size of that population, per unit of time.

Question 17

what is morbidity

Answer 17

Morbidity is the state of being symptomatic or unhealthy for a disease or condition.

Question 18

tell me about electronic prescribing

Answer 18

Electronic prescribing can reduce some types of error e.g. procedural
It may not have a significant impact on clinical errors or errors of omission.
It may also introduce other types of error e.g. system error

Question 19

what is CHD

Answer 19

coronary heart disease

Question 20

tell me about ethnic differneces in CHD

Answer 20

Ethnic Differences in Incidence
* South Asians living in UK – 50% higher premature
deaths in males and 51% in females. Increasing!
* Black Caribbean – 35% lower CHD death rates than rest
of population.

Question 21

CHD and health inequality examples

Answer 21

Ethnic differences
Large regional differences – premature death in Scotland
for males 50% higher than SW (females 80% higher)
* Large socioeconomic differences. Incidence and
outcome e.g. CHD death rate 54% higher in manual
workers than non-manual
* Major factor in reduced life expectancy of people living
in areas of worst deprivation indicators – for males CVD
accounts for 35% of the gap in life expectancy for females
30% of the gap

CVD is more common if a person is male, older, has a
severe mental illness or is of South Asian or African
Caribbean heritage

People who live in the UK’s most deprived areas are 4
times more like to die of a CHD related condition than
some in the least deprived areas.

Question 22

CHD health inequality summary bullet points

Answer 22

living in deprived areas
ethnic differances SA
sosioeconomic differences
male
severe mental illness

Question 23

Reasons for Ethnic Differences

Answer 23

Multifactorial – not all genetic!
* Differences in incidence of a number of CVD risk factors
e.g. hypertension, cholesterol status, BMI, exercise, diet.
* Diabetes is a major factor – again partly genetic but also
other risk factors e.g. exercise and diet

Question 24

what is CVD

Answer 24

cardiovascular disease

Question 25

what is the difference in primary and secondary prevention of CHD

Answer 25

In summary, primary prevention aims to prevent the initial development of CHD in individuals without established cardiovascular disease, while secondary prevention focuses on preventing recurrent events or complications in individuals who already have CHD or have experienced a cardiac event. Both primary and secondary prevention strategies are important in reducing the burden of CHD and improving cardiovascular health.

Question 26

Changes in Death Rates in the UK

Answer 26

CVD death rate falling – by 44% in <75yr 10 years to 2008.
Cancer now major mortality cause in males.
* CHD falling – by 49% in men (55-64) and 26% men (35-
44). Women 55% and no change.
* 60% due to reduced risk factors and the rest to secondary
prevention – main factor smoking

Question 27

Risk Factors for CVD – Non-modifiable

Answer 27

Family history of premature CVD
* Older age,
* Being male,
* Ethnic background (for example, people of South Asian origin have an
increased risk of CVD compared with people of European origin).
* Comorbidities that can increase the risk of developing CVD,
hypertension (the diagnosed condition), diabetes, chronic kidney
disease, dyslipidaemia, rheumatoid arthritis, influenza, serious mental
health problems, and periodontitis

Question 28

CVD Risk Factors Modifiable

Answer 28

high blood pressure (the blood pressure level not the
condition, e.g. the systolic BP down)
* high blood level of non-high density lipoprotein
* smoking/tobacco use
* overweight/obesity
* insufficient physical activity
* poor diet
* psychosocial stress
* excess alcohol consumption

Question 29

Hypertension and CVD

Answer 29

• Risk of cardiovascular disease is directly related to higher levels of
  blood pressure.
• Unhealthy diet is estimated to be responsible for half of hypertension
  with physical inactivity and obesity accounting for 20% each.
• Drug treatment and lifestyle changes, particularly weight loss, physical
  activity and dietary improvements, can effectively lower blood pressure

Question 30

Body Weight and CVD

Answer 30

Overweight and obesity increases the risk of multiple diseases
including CVD, cancer and type 2 diabetes.
* Adults with a body mass index (BMI) (kg/m2) of 25 to 30 are overweight
& with a BMI of over 30 are obese. Both conditions are associated with
increased risk of morbidity and mortality.1
* Abdominal obesity (fat concentrated in the abdomen) is a predisposing
factor for cardiovascular disease.
* The WHO recommended cut-off points, above which individuals are at
risk of metabolic complaints, are for waist circumference 94cm (37
inch) for men and 80cm (31 inch) for women.2
* For waist-hip ratio cut-off points are 0.9 for men and 0.85 for women.

Question 31

Blood Cholesterol and CVD

Answer 31

Blood cholesterol level is positively associated with coronary heart
diseases in both middle and old ages.
* Blood cholesterol levels can be reduced by physical activity, dietary
changes and by drugs.
* High-density lipoprotein cholesterol (HDL) is an independent predictor
of cardiovascular risk, high levels being protective and lower levels
increasing the risk.
* NICE guidelines were revised in 2014, with a new recommendation to
use non-HDL cholesterol, rather than the ratio of total/HDL cholesterol,
as the optimal predictor of CVD risk.

Question 32

NHS Health Check Programme

Answer 32

Everyone aged 40 to 74 years, who have not already been diagnosed
with CVD, diabetes, or chronic kidney disease, is invited once every
five years for a free health check.
* The health check includes a CVD risk assessment, an assessment of
alcohol consumption and physical activity, an assessment for
dementia in those aged 65-74 years, and screening for diabetes and
chronic kidney disease in those at increased risk of developing these
conditions.
* Support and advice to help reduce identified risk factors are included
in the health check

Question 33

CVD Risk Assessment
2 methods

Answer 33

Framingham Method – US Data. Modified for UK
application
* QRISK3 – UK data derived from medical practices.
* Both assess risk of CVD over a 10 year period. Both are
estimates.
* NICE
* Risk <10% offer life style advice
* Risk >10% than life style advice AND consider treatment
of comorbidities and offer atorvastatin 20mg daily if there
are no complications (primary prevention)

Question 34

Framingham Study

Answer 34

began in 1948/50

At each study examination participants are evaluated with medical
histories, physician examinations, laboratory tests for vascular risk
factors, and at some examinations with cognitive test batteries and
brain

Question 35

QRISK3®-2018

Answer 35

.3 million practice patients in England and Wales in 531
practices
* Multiple Risk Factor analysis
* Ethnicity, age and gender
* Townsend Score (social deprivation) – postcode
* Smoking status,
* Diabetes status
* First degree family history CVS
* Treated hypertension, diabetes type 2, renal disease atrial fibrillation,
rheumatoid disease, Systemic Lupus Erythematosus (SLE), Mental illness
* Medication use – e.g. antipsychotic medication/regular steroid tablets
* Systolic blood pressure (mmHg), total cholesterol and High Density
cholesterol, BMI,

Question 36

what is special about QRISK3

Answer 36

BMJ published

Question 37

lifestyle reccomedations excersise

Answer 37

At least 150 minutes per week of moderate intensity
aerobic activity (to the point of slight breathlessness), or
* At least 75 minutes per week of vigorous intensity aerobic
activity, or
* A mix of moderate and vigorous aerobic activity, and
* Muscle-strengthening activities on two or more days a
week that work all major muscle groups (legs, hips, back,
abdomen, chest, shoulders, and arms).

Question 38

Diet – the 5 a Day Approach

Answer 38

Total fat intake should be 30% or less of total energy intake, and
saturated fat <7%. Use olive oil or rapeseed oil rather than animal or
polyunsaturated fats
* Eat at least five portions of fruit and vegetables per day (400g). Eat at
least two portions of fish per week (one oily fish) (140g)
* Eat wholegrain varieties of cereals, breads, and other starchy foods.
Minimise intake of foods containing refined sugars, including fructose
* Keep salt intake low (less than 6 g per day).
* No evidence for Dietary supplements including omega-3 capsules,
plant sterols or supplemented foods

Question 39

Weight and Alcohol Intake

Answer 39

Weight – aim for BMI <25[1] (however lower for Black, Asian and other
minority ethnic group) [2]
* Alcohol Intake [3]
* Unit guidelines are the same for Men and Women = 14 units per week
* Spread evenly across the week
* If you want to cut down the amount you drink – have several drink free days
* The Chief Medical Officer (CMO) guidance is that pregnant women should not drink
any alcohol at all.
* If you are pregnant or planning pregnancy, the safest option is not to drink alcohol.
* This is to keep the risks to your baby to a minimum. The more you drink the greater
the risk to your baby